Prevalence And Characteristics Of Geographic Atrophy In Eyes With Neovascular Age-related Macular Degeneration Treated With Vascular Endothelial Growth Factor Inhibitors **

Purpose: To assess the prevalence and characteristics associated with geographic atrophy (GA) among a cohort of eyes with neovascular age-related macular degeneration (nAMD) that had been treated with vascular endothelial growth factor (VEGF) inhibitors for up to 9 years. Methods: Cross-sectional analysis was performed on treatment-naïve eyes with nAMD tracked by the FRB!outcome registry that commenced anti-VEGF therapy between Jan 1 2006 and Aug 30 2016. Prevalence of GA versus duration of treatment and number injections received were measured. Demographic and clinical characteristics were compared between nAMD with GA to those without. Results: Prevalence of GA in a cohort of 1689 eyes was 9.9% (22/222) in eyes within 1 year of starting treatment, 20.3% (69/339) after 2 years, 41.5% (71/171) after 5 years, and 48.4% (30/62) after 9 years. The strongest risk factor for GA was a higher proportion of visits at which the lesion was graded inactive (AOR 3.7 for lowest vs. highest quartile of active gradings [95% CI 1.9, 6.1]). Other associated characteristics included baseline age, baseline VA and number of injections received. Gender and lesion type were not associated with presence of GA. Conclusions: Prevalence of GA increased with duration of treatment, in eyes that received more injections, with low starting VA and with lower proportion of visits where CNV was active. Despite the observed increase in prevalence, the lack of an untreated control group prevents us concluding whether this was due to anti-VEGF treatment or the natural history of the condition.